Research provides the foundation for high-quality, evidence-based nursing care. However, there isn't a direct flow of knowledge from research into practice. When I ask nurses where the “evidence” to guide the development of “evidence-based care” comes from, I get an interesting array of answers, from “researchers” to blank stares, as if there's no connection between the worlds of researchers and bedside nurses.
If research evidence informs our nursing practice, why doesn't it come from all of us? Nurses are inquisitive, think critically about their patients’ care, and want to know the best treatments for their patients—all of which makes them perfectly suited for research. Though the majority of nurses don't have the training to conduct research projects without assistance, they know how to ask questions and they know which questions need answering.
Yet research is often perceived as something undertaken by others far removed from the front lines of nursing practice. I believe that many nurses’ notions about who does or doesn't do research are rooted in our identity as nurses, which often manifests in a belief that “good” nurses are not researchers but instead have excellent clinical skills and can manage any crisis on a unit. A 2007 study by Woodward and colleagues in the Journal of Research in Nursing found that nurse clinicians engaged in research often perceive a lack of support from nurse managers and resentment from colleagues who see the research as taking them away from clinical practice.
The distinction often drawn between nursing research and clinical practice is mirrored in the inconsistent translation of research evidence into practice. Despite widespread promotion of evidence-based practice in nursing, creation of new translational research roles for nurses in major medical centers, and Medicare reimbursement policies in the United States tied to implementation of specific evidence-supported practices, studies continue to suggest much room for improvement. In a September 2014 article in this journal, Yoder and colleagues noted that researchers have consistently found that “nurses who valued research were more likely to use research findings in practice.” Such observations suggest a need for a much stronger link between nurse clinicians and the development of research into best practices. Though this has been discussed for years, I do not yet see research as having infiltrated fundamental views of what constitutes “nursing work.”
My discussions with frontline nurses and nurses involved in research have led me to ask three key questions that need addressing before we can fully integrate research into our professional identity. These are:
- How can nurses strive for high-quality research without focusing on randomized controlled trials?
- What are the barriers to and challenges of being involved in research and how can we address these?
- How can nurses at varying education levels be involved in research?
Nurses could turn many quality improvement (QI) projects into research. Research may be viewed as a continuum, with formal projects at one end and QI projects somewhere along the continuum. Though nurses may not think that QI projects would be of interest to others, with increased understanding of the research process and greater institutional support, some QI projects could easily become research projects.
More bedside nurses are likely to engage in research if
- nursing education is strengthened.
- time away from direct care is allocated for conducting research activities.
- consultant resources such as methodologists and biostatisticians are available to staff.
- institutional and organizational support of research are strengthened.
Many nurses are intimidated by research, but change is possible if we stop seeing research as someone else's job and start making it a part of who we are and what we do. This will pave the way to evidence-based practice truly becoming the norm.